Table 3 Additional quotations from interviews organized by theme

Active, intentional outreach

“You can know who the director is. But if you want to get Mary or Johnny into the program, it’s good to know who the impact person is to expedite the process rather than just looking at a name on a directory, which would be my name, but I may not be the best person to call. You might need the person down the hall. So it’s about maintaining those relationships that makes the hand-off more friendly and quicker.” (Metro Health ID 1, clinical role)

“When I first started building my relationships, I would just call around. I would literally go to relink.org and I would call agencies just at random and question and talk to them about what their services were, what patients they were willing to accept, age group, payer sources. That’s how I built most of my relationships was just randomly calling agencies here and there and talking over the phone with them.” (Lake Health ID 2, clinical role)

“I really did some cold calling six years ago when I started… So when I got in the position, it was really, okay. So who does residential? Who does detox? Who does IOP? Who does OP? And calling, hi, my name is [name]. I’m calling from Cook County. Tell me a little bit about your program. And then it’s like, okay, well I’m going to be seeing patients in the emergency room and I would love to connect them to your organization. Give me a point person, what’s their extension? What do you need me to fax you? I have a release of information. What else do we need to do? And it really, six years later, and I’m still in communication with most of those treatment facilities, now you have the resolving door people that leave those organizations turnover. But as far as the partnership and making sure that the patients get into a higher level of care, that’s still there. But it started from really cold calling. I don’t know. I was like, I’m just going to go down this Rolodex here and see what happens.” (City Health ID 3, non clinical staff role)

“We go to these events, and the events that we go to, usually there are many, many tables of other facilities, that they get up and they say, “Okay, this is what we offer.” And [name] and I sit there in the background saying, “That would be a great place.” So we go to that table, we talk to those people, we get their cards, we get their information… So these events that we go to, I think, is our biggest source of information” (Mountain Health ID 1, clinical support role)

Responding to a community need

“The whole community was on board. They seen there’s a need, even though it’s several different facilities, we’re all in it for the same reason. And there are plenty of people with addiction to go around, unfortunately.” (Mountain Health ID 1, non clinical support)

“I think communication’s key. And these I see as not only individual or organizational issues to develop strategies around, we see it as a community problem and a community need. And so I think convening regular times or meetings when we can, as a community, sit down and talk about the issues of mutual concerns for all of us, and then work to develop strategies to impact that together versus working in our silos.” (Lake Health ID 7, administrative role at CBO)

External Enabling Factors

“The [Title] Network is one that allows us to connect, so I get referrals at my clinics from private universities and patients being referred through that, which is really wonderful so I could go both directions… it functionally is a website. The website basically reserves a day for follow-up with the patient. The patient, before they leave the emergency department, they know, “Okay, Wednesday the 23rd, you’re going to follow-up at this clinic.” It doesn’t give them a time, but it gives them at least a day.” (Metro Health ID 3, administrative role)

“And the big thing obviously was to assure linkage into the community. So outside of the doctor meetings, then we had leaders from our community resources, which is our community board. And then two of our community agencies, they also joined our group. And what we set up was if our ER doc would prescribe the Suboxone to guarantee linkage out within 24 hours. So [the community board] set up a process to do that” (Mountain Health ID 5, clinical role)

Leveraging reputations and connections to community

“Over time, it’s our ability to engage people in the next step and then show the hospital what we’re doing to build that reputation and that comfort level.” (City Health ID 5, administrative role at CBO)

“My honest opinion is those key players involved with the collaborations are long-term folks…Matter of fact, some of them I worked with since I was 19. I mean very, very long-term and committed folks in these positions. So I feel like that’s what helps the collaboration to continue across the years.” (Lake Health ID 1, administrative role)

“I think the biggest thing that I could share in that regard…is that our current CEO used to be on the board of one of these community substance use programs.” (Metro Health ID 1, clinical role)

Focus on operations

“And then also making sure that there’s operations connections to work through kinks, and communication when something’s not working. Something might be really bugging us that they do, that they might be like, “We don’t have to do it that way.” (City Health ID 2, clinical role)

“We’ll invite [our partners] to our service line meeting we have once a month, we’ll invite them in to talk about any challenges and they’ll be part of those conversations, which like I said, five to seven years ago that communication wasn’t there.” (Lake Health ID 3, clinical role)

“We have a business relationship in the sense that methadone programs hear from us all the time because we’re verifying doses for patients that are here. They hear from us all the time because we’re trying to coordinate transition from inpatient to outpatient for a lot of people. And so we operate on a business level that way.” (Metro Health ID 1, clinical role)

“So when we’d have our meetings, what they would talk about is, so, “What if we signed somebody up, say at Integrated Services, and they start there but we’re finding out maybe Health Recovery would’ve been a better choice.” Everyone talked about, “Well, how would that work? Would you be okay to transfer?” And people’s like, “Yeah, it’s about the patient.“” (Mountain Health ID 1, non clinical staff role)

Reciprocal relationships

“We have a community treatment provider that again offers a lot of the higher levels of care that we don’t. And so a lot of times patients will come to us for the medication, but we’ll go to them for the IOP, the residential, the whatever.” (City Health ID 1, administrative role)

“We have agreements, professional agreements signed, collaborative agreements with certain entities. But really even without those, we would still work very closely together. They have services that we need for our patients and we have services that they need for their patients. So that’s what really drives that connection, I think.” (Lake Health ID 1, clinical role)

“So we’re doing a joint meeting with [partner organization’s] staff and our staff… Because we don’t currently have inpatient detox, so we have relationships with many programs and we cross-mingle and refer to them and they refer to us.” (Metro Health ID 2)

Building Infrastructure and Processes to Ensure Collaboration

“Your specific subject on hospitals, we’ve had longstanding relationships with hospitals in Illinois. We’re currently in nine hospitals, and we’re providing a variety of services in those nine hospitals.” (City Health ID 5, administrative role at CBO)

“We are completely separate entities and we outreach and connect and have created this informal collaboration where they provide the support and the structure.” (Metro Health ID 1, clinical role)

“We are trying to align intentionally the work that we do so that we could leverage resources, leverage human capital and build stronger pathways for and reduce duplication of efforts as we try to do this together.” (Lake Health ID 7, administrative role at CBO)